The costs of head injuries

March 2012

Head injuries are the most common severe injuries for children. Even a mild head injury can have lasting effects and more severe injuries cause permanent damage to the brain which can drastically change the lives of the injured child and their family. This article gives an overview of the financial and emotional costs of head injuries among children.

As NHS treatment costs vary widely, all of the costs shown should be treated as a guide.

NICE defines a head injury as any trauma to the head other than shallow injuries on the surface of the face. A severe head trauma can cause injuries to the brain, which is known as traumatic brain injury. The range of severity in head injuries is very broad, from a concussion with no lasting damage, to long-term cognitive and behavioural problems, permanent disability, persistent vegetative states, or fatality.

The scale of the problem

Around 295,000 under-16s attend A&E with head injuries each year in England.1 Most head injuries are minor but 1 in 10 is moderate to severe.

In England during 2010/11, around 36,500 children under 14 were admitted to hospital with head injuries.2

Traumatic brain injury accounts for 30% of childhood deaths due to external causes of injury in 1-14 year olds. Children living in deprived areas are more likely to sustain severe traumatic brain injury.3

Falls and road-traffic accidents are the most common causes of injury, with falls most predominant in the under-2s.

Table 1: Key costs for treating head injuries in children and young people

Item

Cost

Cost Annual cost of hospital admissions in under-14s

£115 million 1,2

Annual cost of CT scans of the head in under-16s

£5.87 million1

Cost of a bed in a paediatric intensive care unit (PICU)

£2,3274

Average stay of 3 days in PICU

£6,9814,5

100 days of specialist inpatient rehabilitation for a traumatic brain injury

£43,1004

Approximate lifetime medical, educational and social costs for one child with a severe traumatic brain injury

£4.89 million6

The financial costs

A&E and hospital admissions

Each year around 295,000 under-16s attend A&E with head injuries – this age group makes up around 40% of all people presenting with head injuries.1 Most head injuries are minor, but 1 in 10 is moderate to severe.

In England in 2010/11, 36,513 under-14s were admitted to hospital with injuries to the head.2 Based on an average cost of £3,150 per person1, these admissions cost a total of £115 million. Of those admitted to hospital, 97% are discharged within 48 hours.7

Table 2: Number of children affected by different types of head injury and the average length of stay in hospital8

Type of head injury

Number of cases among 0-14 year olds in 2010/11

Average length of stay across all ages of patients

Open wound

11,185

1.4 days

Superficial injury

9,118

1.6 days

Fracture of skull and facial bones

3,681

2.2 days

Intracranial injury

1,730

13.5 days

Investigations that may be carried out in A&E or as an inpatient include skull x-rays and CT scans of the head. NICE estimates that each year, 40,800 under-16s with head injuries require a CT scan, at a total cost of around £5.87 million.1

Brain injuries

A severe head injury can cause injuries to the brain. Each year in England, around 5 children per 100,000 population are admitted to a paediatric intensive care unit (PICU) with a life-threatening traumatic brain injury.3 Unless the child is already at a hospital with a PICU facility, they will require paediatric critical care transportation to a tertiary facility at a cost of £2,417 per transfer.4 With one bed day in PICU costing £2,327,4 the average stay for traumatic brain injury of 3 days comes to £6,981. One in 5 of those admitted to PICU will require emergency neurosurgery, for example to remove a clot or to insert a drain to relieve pressure on the brain.9

Children who have suffered a brain injury are likely to need specialised rehabilitation which could include physiotherapy, occupational therapy, speech and language therapy, play and music therapy, and clinical psychology. Children with severe brain injuries will be admitted to a neurological rehabilitation unit at a cost of £431 a day.4 A typical stay of around 100 days would cost £43,100.

Research published in the BMJ on the long-term impact of head injuries in adults and young people over the age of 15 shows that head injury is associated with increased vulnerability to death from a variety of causes for at least 13 years after hospital admission.

Lifelong costs

In a study of patients over the age of 5, an estimated 15% of cases of fractured skulls and 5% of intracranial injuries were found to have lifelong impact.10

The Meningitis Research Foundation’s 2011 report Counting the cost: a severe case of bacterial meningitis provides a detailed analysis of the lifelong medical, educational and social costs involved in caring for and supporting a three year old child who experiences severe neurological damage as a result of meningitis. Although the brain injury detailed in the report is caused by meningitis rather than trauma, the treatment, rehabilitation and long-term needs are comparable to those required for a severe traumatic brain injury.6

Table 3: An indication of the lifelong medical, educational and social costs for a child who suffers a severe traumatic brain injury at the age of three

Total cost of lifelong care and support (excludes the ‘human cost’ in terms of pain, grief and suffering experienced)

£4.89 million

The cost burden on families

When a child is in hospital for an extended period of time, parents may have to take large amounts of time off work to stay with their child, as well as for clinic visits and outpatient appointments once they have been discharged. Parents may also have to pay the costs of travelling to the hospital where their child is being treated, which could be some distance from the family home.

Raising a disabled child can place a significant financial strain on a family. The cost of raising a severely disabled child is three times higher than the cost of raising a child without a disability. At the same time, household income in families with a disabled child is around 24% below the UK average. Only 16% of mothers of a disabled child work, compared to 61% of other mothers.11

In this interview, Dr Andrew Curran, a leading consultant paediatric neurologist from Alder Hey Children’s Hospital, provides insights into the hidden costs for families of a child suffering a serious head injury:

The emotional costs

The effect on the child

A minor head injury can lead to short-term problems such as headaches, memory loss or difficulties with concentration – collectively known as post-concussion syndrome. Following a serious head injury, children may experience a wider range of difficulties relating to physical ability, thinking, emotions and behaviour. Typical problems include tiredness and fatigue, difficulties with organising and planning, depression, anxiety, impulsiveness and aggression. An acquired brain injury is often known as the 'hidden disability' because in many cases, there are no external signs of the injury.

In adults, the greatest improvements after a serious head injury generally take place within the first two years. But for children, it can take months or years to see the full effects of a head injury. This is because the brain takes around 20 years to develop, and it is only when the injured part of the brain develops that the extent of the injury is revealed. Problems caused by a head injury often become much apparent during the teenage years when a young person starts to refine skills such as independence and life-planning.

Intensive care treatment can have a lasting psychological effect on children, with 1 in 3 children experiencing nightmares or upsetting hallucinations following a stay in PICU.12

There is research which suggests there may be a link between traumatic brain injury and subsequent offending and we know that brain injury is caused as a result of falls, sporting accidents, road accidents and violence.13

The effect on the family

The families of children who have suffered a serious head injury may have to come to terms with dramatic changes in the child’s physical and cognitive abilities, personality and behaviour. Personality and behavioural changes can include aggressiveness, sudden mood changes, self-centredness, social and sexual disinhibition, poor motivation and a lack of empathy. Parents of children who develop extreme behavioural problems may find themselves in a position where no-one outside the family can look after their child, leaving them unable to get a break or maintain their social links. Behavioural problems are considered to be the leading cause of parents separating following a disabling injury.

Among parents of children with traumatic brain injury, 41% have clinically significant levels of stress, compared to just 3% of parents of healthy children. These families are also more likely to have relationship problems and financial difficulties.14

For families whose child is treated in PICU, having to face the very real prospect of losing their child is deeply traumatic. Siblings may feel excluded as their parents naturally focus their energies on the child who has been hurt.

Ben’s story

When he was 16 years old, Ben Quick was hit by a car near his home in Newport, Barnstaple. He was lucky to survive but was left with a brain injury that was to change his life. The severity of the accident meant that Ben was in an induced coma for 17 days after the accident, to help reduce the swelling in his brain. The impact was so heavy that he had to have reconstructive surgery to his head and face. In total, Ben spent 10 weeks in Frenchay Hospital, Bristol, fighting for his life.

Ben had lost the sight in his right eye and his sense of smell, and his short-term memory was severely affected. As he'd damaged his frontal lobe, filtering information was very difficult and he struggled with sensory overload.

With the help of the doctors, his family and Headway, Ben started to make good progress and went back college to continue his A-levels. However, his brain injury took its toll and Ben began to struggle with his courses, which all required his brain to function in a certain way. Rather than give up, he decided to start again - this time with courses to suit what he could do, not what he couldn't. His brain injury means that although he now struggles with processing information, his visual skills are intact, so he chose to study art, graphics, media and music.

Two years after the accident, Ben obtained A-levels in three subjects and went on to study for a degree in illustration at Plymouth University. Ben said: "I'm 23 now and I've got my life back on track, but my brain injury will always be with me. I will never regain the sight in my right eye or my sense of smell and I still suffer from short-term memory and concentration issues. It's frustrating but I try to not let it affect me in a negative way.”

How could it be prevented?

Head injuries have a wide range of causes, the most common of which are falls and collisions with vehicles, as a pedestrian, cyclist or as a vehicle occupant. Falls are the most common cause of head injuries in young children, while older children are more likely to receive a head injury from an accident on the roads.

CAPT’s Look Who’s Falling DVD resource pack educates parents about the risks of serious falls to under fives and what they can do to prevent them. Nine out of ten parents who viewed the film said they would take action to stop their child being badly hurt in a serious fall.

The self-contained pack, which includes a 15-minute film, support cards to facilitate discussions and 50 falls flyers, is designed to help practitioners deliver engaging and effective sessions for parents. The film focuses on three serious accident scenarios: falls downstairs, from highchairs and from windows. The film includes parents’ stories, shots from the child’s point of view and an interview with Dr Andrew Curran highlighting the consequences of a serious fall.

For more information on preventing head injuries, see CAPT’s practitioner advice on the CAPT website:

6 For more detail on the costs see Counting the cost: a severe case of bacterial meningitis.The comparability between the costs in this report and the costs involved in a severe traumatic brain injury was confirmed by Phil Hyde, Paediatric Intensivist at University Hospital Southampton. Based on his advice, we made slight adjustments to the medical costs to account for differences in treating an acquired brain injury caused by meningitis and one caused by trauma.